摘要
[目的]评价应用Corail羟基磷灰石全涂层股骨柄假体行全髋置换术治疗老年股骨颈骨折的中期疗效,并初步观察Corail假体在国人股骨髓腔中的下沉规律。[方法]对本院于2006年5月∽2008年2月采用Corail假体行全髋置换术治疗的64例（64髋）老年股骨颈骨折患者病例资料进行回顾性分析。骨折Garden分型：Ⅲ型37例,Ⅳ型27例。所有患者于术前、术后行X线片,观察假体初始位置及下沉、应力遮挡性骨吸收、透亮区、骨溶解、异位骨化,按Engh标准评定假体的生物学固定,按Gruen法描述股骨柄分区,按Brooker标准对异位骨化进行分级。[结果]本组64例患者中,6例于术后3个月内失访,其余58例均获得5年以上（5.5∽7.5）年随访,平均6.7年。术后切口均Ⅰ期愈合,无感染及血管、神经损伤并发症。其中,1例下肢深静脉血栓及1例术后髋关节脱位均经保守治疗后痊愈,3例出现BrookerⅠ级异位骨化,无特殊不适。随访末按Engh标准评定,58例假体均稳定,其中骨性固定53例（91.4%）,纤维性固定5例（8.6%）。以Corail假体的无菌性松动和任何原因导致的翻修作为终点事件进行评估,随访末假体生存率为100%。患者髋关节功能从术前Harris评分平均47.5分改善至术后1年的平均89.1分及末次随访的平均90.4分,术后1年及末次随访时评分均优于术前,比较差异均有统计学意义（P〈0.05）。随访末患者SF-36评分结果仅生理职能、活力得分较参考值低外,其余各项得分与参考值比较差异均无统计学意义。[结论]采用Corail羟基磷灰石全涂层股骨柄假体行全髋置换术治疗老年股骨颈骨折能获得良好的假体稳定性,显著改善患者关节功能,并能获得较好的生存质量,且并发症较少,中期疗效满意。同时,Corail柄在国人股骨髓腔中的下沉主要发生于术后6个月内。
[Objective]To evaluate the mid-term results of total hip arthroplasty（ THA） with Corail entirely hydroxyapatite（ HA）- coated femoral prosthesis for elderly femoral neck fracture,and to preliminarily find out the subsidence pattern of Corail prosthesis in the medullary cavity of Chinese femur. [Method]A total of 64 cases（64 hips） of THA from May 2006 to Feb 2008 using Corail femoral prosthesis for elderly femoral neck fracture were reviewed. Cases of Garden typeⅢ fracture were37 and type Ⅳ 27. The X- ray films were taken at pre- and post- operation for all the patients to observe the initial fixation and subsidency of the stem,stress- shielding resorption of bone,radiolucency and osteolysis around the stem. The radiologic evaluation system of Engh et al. was used for biological fixation. The zonal system described by Gruen et al. was adopted to record the site of demarcation of stems. Ectopic ossification was classified according to the system described by Brooker et al. Function of the hip was assessed based on the evaluation system of Harris. Life quality of patients was evaluated by short- form 36 health survey scale（ SF- 36） and the results were compared with a reference value. The complications were recorded. [Result]Six patients lost follow- up in three month after operation,while the other 58 patients were followed up for more than 5 years（5. 5 ~7. 5 years,with an average of 6. 7 years）. In the 58 cases,all the incisions healed by first intention. No infection,blood vessel injury and nerve injury occurred. One deep vein thrombosis and one hip dislocation occurred after operation,which were healed by conservative treatment. Mild ectopic ossification（ BrookerⅠ） occurred in 3 patients who had no discomfort. According to the evaluation system of Engh,all the 58 stems were radiographically stable at the latest follow- up,including osseointegration in 53 hips and secondary successful implant stabilization in 5 hips. The survival rates of the stems were 100% at last follow- up,if aseptic loosening and any revision of the stem were defined as the endpoint. The mean preoperative Harris hip score was 47.5 points,which was improved to 89. 1 immediately after operation and 90. 4 points at the latest follow- up,and the results at 1 year postoperatively and last follow- up were significantly better than preoperative ones（ P 0. 05）. There was no reported incidence of severe thigh pain. Only the physiological role and vitality scores of the SF- 36 were significantly lower than the reference value,and no significant difference was found in the other scores of the SF- 36 when compared with the reference value at the latest follow- up. [Conclusion]The THA with Corail entirely HA- coated femoral prosthesis for elderly femoral neck fracture has a fine prosthesis stability,a significantly improved function and good life quality,and also a low complication incidence in a mid- term follow up. In addition,the subsidence of Corail stem has been mainly observed in the first six months after operation in Chinese.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2015年第10期887-891,共5页
Orthopedic Journal of China
关键词
羟基磷灰石
全髋置换术
股骨颈骨折
下沉
hydroxyapatites total hip arthroplasty femoral neck fracture subsidence
